|
CHANGE OF CYCTOSTOMY TUBE; SIMPLE
|
Facility
OP
|
$475.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: AETNA Commercial |
$451.25
|
| Rate for Payer: AETNA Medicare |
$427.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$451.25
|
| Rate for Payer: BCBS Healthlink |
$427.50
|
| Rate for Payer: BCBS HMK CHIP |
$427.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$427.50
|
| Rate for Payer: BCBS POS |
$451.25
|
| Rate for Payer: BCBS Traditional |
$475.00
|
| Rate for Payer: CASH_PRICE |
$380.00
|
| Rate for Payer: CIGNA Commercial |
$451.25
|
| Rate for Payer: CIGNA Medicare |
$427.50
|
| Rate for Payer: HUMANA Commercial |
$427.50
|
| Rate for Payer: MEDICAID Medicaid |
$437.00
|
| Rate for Payer: MEDICARE Medicare |
$332.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$451.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$460.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$451.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$451.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$380.00
|
|
|
CHANGE OF CYCTOSTOMY TUBE; SIMPLE
|
Facility
IP
|
$475.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: BCBS HMK CHIP |
$427.50
|
| Rate for Payer: AETNA Commercial |
$451.25
|
| Rate for Payer: AETNA Medicare |
$427.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$451.25
|
| Rate for Payer: BCBS Healthlink |
$427.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$427.50
|
| Rate for Payer: BCBS POS |
$451.25
|
| Rate for Payer: BCBS Traditional |
$475.00
|
| Rate for Payer: CASH_PRICE |
$380.00
|
| Rate for Payer: CIGNA Commercial |
$451.25
|
| Rate for Payer: CIGNA Medicare |
$427.50
|
| Rate for Payer: HUMANA Commercial |
$427.50
|
| Rate for Payer: MEDICAID Medicaid |
$437.00
|
| Rate for Payer: MEDICARE Medicare |
$332.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$451.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$460.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$451.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$451.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$380.00
|
|
|
CHarge Only (DICYCLOMINE HCL) 10mg/5ml
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CHarge Only (DICYCLOMINE HCL) 10mg/5ml
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
Charge Only (LIDOCAINE VISCOUS 2%)
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
Charge Only (LIDOCAINE VISCOUS 2%)
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-N
|
Facility
OP
|
$330.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: AETNA Commercial |
$313.50
|
| Rate for Payer: AETNA Medicare |
$297.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$313.50
|
| Rate for Payer: BCBS Healthlink |
$297.00
|
| Rate for Payer: BCBS HMK CHIP |
$297.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$297.00
|
| Rate for Payer: BCBS POS |
$313.50
|
| Rate for Payer: BCBS Traditional |
$330.00
|
| Rate for Payer: CASH_PRICE |
$264.00
|
| Rate for Payer: CIGNA Commercial |
$313.50
|
| Rate for Payer: CIGNA Medicare |
$297.00
|
| Rate for Payer: HUMANA Commercial |
$297.00
|
| Rate for Payer: MEDICAID Medicaid |
$303.60
|
| Rate for Payer: MEDICARE Medicare |
$231.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$313.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$320.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$313.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$313.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$280.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$264.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$264.00
|
|
|
CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-N
|
Facility
IP
|
$330.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: BCBS HMK CHIP |
$297.00
|
| Rate for Payer: AETNA Commercial |
$313.50
|
| Rate for Payer: AETNA Medicare |
$297.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$313.50
|
| Rate for Payer: BCBS Healthlink |
$297.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$297.00
|
| Rate for Payer: BCBS POS |
$313.50
|
| Rate for Payer: BCBS Traditional |
$330.00
|
| Rate for Payer: CASH_PRICE |
$264.00
|
| Rate for Payer: CIGNA Commercial |
$313.50
|
| Rate for Payer: CIGNA Medicare |
$297.00
|
| Rate for Payer: HUMANA Commercial |
$297.00
|
| Rate for Payer: MEDICAID Medicaid |
$303.60
|
| Rate for Payer: MEDICARE Medicare |
$231.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$313.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$320.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$313.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$313.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$280.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$264.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$264.00
|
|
|
CHEST SEAL
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
CHEST SEAL
|
Facility
IP
|
$28.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
CHEST TUBE INSERTION TRAY
|
Facility
IP
|
$248.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: BCBS HMK CHIP |
$223.20
|
| Rate for Payer: AETNA Commercial |
$235.60
|
| Rate for Payer: AETNA Medicare |
$223.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$235.60
|
| Rate for Payer: BCBS Healthlink |
$223.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$223.20
|
| Rate for Payer: BCBS POS |
$235.60
|
| Rate for Payer: BCBS Traditional |
$248.00
|
| Rate for Payer: CASH_PRICE |
$198.40
|
| Rate for Payer: CIGNA Commercial |
$235.60
|
| Rate for Payer: CIGNA Medicare |
$223.20
|
| Rate for Payer: HUMANA Commercial |
$223.20
|
| Rate for Payer: MEDICAID Medicaid |
$228.16
|
| Rate for Payer: MEDICARE Medicare |
$173.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$235.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$240.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$235.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$235.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$210.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$198.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$198.40
|
|
|
CHEST TUBE INSERTION TRAY
|
Facility
OP
|
$248.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: AETNA Commercial |
$235.60
|
| Rate for Payer: AETNA Medicare |
$223.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$235.60
|
| Rate for Payer: BCBS Healthlink |
$223.20
|
| Rate for Payer: BCBS HMK CHIP |
$223.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$223.20
|
| Rate for Payer: BCBS POS |
$235.60
|
| Rate for Payer: BCBS Traditional |
$248.00
|
| Rate for Payer: CASH_PRICE |
$198.40
|
| Rate for Payer: CIGNA Commercial |
$235.60
|
| Rate for Payer: CIGNA Medicare |
$223.20
|
| Rate for Payer: HUMANA Commercial |
$223.20
|
| Rate for Payer: MEDICAID Medicaid |
$228.16
|
| Rate for Payer: MEDICARE Medicare |
$173.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$235.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$240.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$235.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$235.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$210.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$198.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$198.40
|
|
|
CHIRO ADJ 1-2 REG
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 98940 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: AETNA Commercial |
$46.55
|
| Rate for Payer: AETNA Medicare |
$44.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$46.55
|
| Rate for Payer: BCBS Healthlink |
$44.10
|
| Rate for Payer: BCBS HMK CHIP |
$44.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$44.10
|
| Rate for Payer: BCBS POS |
$46.55
|
| Rate for Payer: BCBS Traditional |
$49.00
|
| Rate for Payer: CASH_PRICE |
$39.20
|
| Rate for Payer: CIGNA Commercial |
$46.55
|
| Rate for Payer: CIGNA Medicare |
$44.10
|
| Rate for Payer: HUMANA Commercial |
$44.10
|
| Rate for Payer: MEDICAID Medicaid |
$45.08
|
| Rate for Payer: MEDICARE Medicare |
$34.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$46.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$47.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$46.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$46.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$41.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$39.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$39.20
|
|
|
CHIRO ADJ 1-2 REG
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 98940 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: AETNA Commercial |
$46.55
|
| Rate for Payer: AETNA Medicare |
$44.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$46.55
|
| Rate for Payer: BCBS Healthlink |
$44.10
|
| Rate for Payer: BCBS HMK CHIP |
$44.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$44.10
|
| Rate for Payer: BCBS POS |
$46.55
|
| Rate for Payer: BCBS Traditional |
$49.00
|
| Rate for Payer: CASH_PRICE |
$39.20
|
| Rate for Payer: CIGNA Commercial |
$46.55
|
| Rate for Payer: CIGNA Medicare |
$44.10
|
| Rate for Payer: HUMANA Commercial |
$44.10
|
| Rate for Payer: MEDICAID Medicaid |
$45.08
|
| Rate for Payer: MEDICARE Medicare |
$34.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$46.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$47.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$46.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$46.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$41.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$39.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$39.20
|
|
|
CHIRO ADJ 3-4 REG
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 98941 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
CHIRO ADJ 3-4 REG
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 98941 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
CHIRO ADJ 5 REG
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 98942 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: AETNA Commercial |
$71.25
|
| Rate for Payer: AETNA Medicare |
$67.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$71.25
|
| Rate for Payer: BCBS Healthlink |
$67.50
|
| Rate for Payer: BCBS HMK CHIP |
$67.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$67.50
|
| Rate for Payer: BCBS POS |
$71.25
|
| Rate for Payer: BCBS Traditional |
$75.00
|
| Rate for Payer: CASH_PRICE |
$60.00
|
| Rate for Payer: CIGNA Commercial |
$71.25
|
| Rate for Payer: CIGNA Medicare |
$67.50
|
| Rate for Payer: HUMANA Commercial |
$67.50
|
| Rate for Payer: MEDICAID Medicaid |
$69.00
|
| Rate for Payer: MEDICARE Medicare |
$52.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$71.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$72.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$71.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$71.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$63.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.00
|
|
|
CHIRO ADJ 5 REG
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 98942 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: AETNA Commercial |
$71.25
|
| Rate for Payer: AETNA Medicare |
$67.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$71.25
|
| Rate for Payer: BCBS Healthlink |
$67.50
|
| Rate for Payer: BCBS HMK CHIP |
$67.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$67.50
|
| Rate for Payer: BCBS POS |
$71.25
|
| Rate for Payer: BCBS Traditional |
$75.00
|
| Rate for Payer: CASH_PRICE |
$60.00
|
| Rate for Payer: CIGNA Commercial |
$71.25
|
| Rate for Payer: CIGNA Medicare |
$67.50
|
| Rate for Payer: HUMANA Commercial |
$67.50
|
| Rate for Payer: MEDICAID Medicaid |
$69.00
|
| Rate for Payer: MEDICARE Medicare |
$52.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$71.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$72.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$71.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$71.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$63.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.00
|
|
|
CHIRO ADJ EXTR
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 98943 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
CHIRO ADJ EXTR
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 98943 AT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
CHLAMYDIA TRACHOMATIS AMP. PROBE TECH
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: AETNA Commercial |
$132.05
|
| Rate for Payer: AETNA Medicare |
$125.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$132.05
|
| Rate for Payer: BCBS Healthlink |
$125.10
|
| Rate for Payer: BCBS HMK CHIP |
$125.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$125.10
|
| Rate for Payer: BCBS POS |
$132.05
|
| Rate for Payer: BCBS Traditional |
$139.00
|
| Rate for Payer: CASH_PRICE |
$111.20
|
| Rate for Payer: CIGNA Commercial |
$132.05
|
| Rate for Payer: CIGNA Medicare |
$125.10
|
| Rate for Payer: HUMANA Commercial |
$125.10
|
| Rate for Payer: MEDICAID Medicaid |
$127.88
|
| Rate for Payer: MEDICARE Medicare |
$97.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$132.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$134.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$132.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$132.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
|
CHLAMYDIA TRACHOMATIS AMP. PROBE TECH
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: AETNA Commercial |
$132.05
|
| Rate for Payer: AETNA Medicare |
$125.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$132.05
|
| Rate for Payer: BCBS Healthlink |
$125.10
|
| Rate for Payer: BCBS HMK CHIP |
$125.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$125.10
|
| Rate for Payer: BCBS POS |
$132.05
|
| Rate for Payer: BCBS Traditional |
$139.00
|
| Rate for Payer: CASH_PRICE |
$111.20
|
| Rate for Payer: CIGNA Commercial |
$132.05
|
| Rate for Payer: CIGNA Medicare |
$125.10
|
| Rate for Payer: HUMANA Commercial |
$125.10
|
| Rate for Payer: MEDICAID Medicaid |
$127.88
|
| Rate for Payer: MEDICARE Medicare |
$97.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$132.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$134.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$132.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$132.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
|
CHLAMYDIA TRACHOMATIS, NAA (188078)
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
